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Sandhu S, Sharpe M, Findlay Ú, Roe C, Broggio J, Spencer K, Thackray K. Cohort profile: radiotherapy dataset (RTDS) in England. BMJ Open 2023; 13:e070699. [PMID: 37339842 DOI: 10.1136/bmjopen-2022-070699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
PURPOSE The purpose of the Radiotherapy Dataset (RTDS) is to collect consistent and comparable data across all providers of National Health Service (NHS)-funded radiotherapy and to provide intelligence for service planning, commissioning, clinical practice and research. PARTICIPANTS The RTDS is a mandated dataset requiring providers to collect and submit data monthly for patients treated in England. Data is available from 01 April 2009 to 2 months behind the calendar month.The National Disease Registration Service (NDRS) started receiving data from 01 April 2016. Prior to this, the National Clinical Analysis and Specialised Applications Team (NATCANSAT) were responsible for the RTDS. NDRS holds a copy of the NATCANSAT data for English NHS providers.The RTDS contains clinical information on the primary disease being treated, modality and intent of treatment, dose fractionation and hospital appointment details. Due to constraints in RTDS coding, linkage to the English National Cancer Registration dataset is beneficial. FINDINGS TO DATE The RTDS has been linked to the English National Cancer Registration and Systemic Anti-Cancer Therapy (SACT) datasets and to Hospital Episode Statistics (HES) to provide a more complete picture of the patient cancer pathway. Findings include a study to compare outcomes for patients treated with radical radiotherapy, an investigation of factors influencing 30-day mortality, assessing sociodemographic variation in the use of treatment and a study to assess the service impact of the COVID-19 pandemic. A range of other studies have been completed or are ongoing currently. FUTURE PLANS The RTDS can be used for a variety of functions including cancer epidemiological studies to investigate inequalities in treatment access; provide service planning intelligence; monitor clinical practice; and support clinical trial design and recruitment. Collection is to continue indefinitely, with regular updates to the data specification to enable capture of more detailed information on radiotherapy planning and delivery.
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Affiliation(s)
- Sabrina Sandhu
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Michael Sharpe
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Úna Findlay
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
- Medical Exposures Group, UKHSA, Chilton, UK
| | - Catherine Roe
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - John Broggio
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Katie Spencer
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Dennis K, Linden K, Gaudet M. A shift from simple to sophisticated: using intensity-modulated radiation therapy in conventional nonstereotactic palliative radiotherapy. Curr Opin Support Palliat Care 2023; 17:70-76. [PMID: 36695868 DOI: 10.1097/spc.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The authors aimed to highlight trends in, and evidence underlying the use of highly conformal radiotherapy (RT) techniques in conventional nonstereotactic palliative RT. The authors reviewed palliative-intent and curative-intent studies relevant to the use of intensity-modulated radiation therapy (IMRT) for the delivery of nonstereotactic conventional regimens to the brain, head and neck, thorax, abdomen and pelvis, and bone metastases. RECENT FINDINGS The use of IMRT has become standard with certain indications for brain metastases such as hippocampus-avoiding/limiting whole brain RT. IMRT in the treatment of bone metastases is increasing at many institutions despite limited data comparing its effectiveness with that of fluoroscopy-based and three-dimensional conformal radiation therapy techniques. There is scant data describing the use of IMRT for palliation in other extracranial anatomic sites; guidance for its use in these settings must be gleaned almost exclusively from curative-intent randomized trials, consensus recommendations and contouring atlases. SUMMARY Consistent with historical technology shifts in RT practice, the uptake of highly conformal techniques such as IMRT for conventional palliative RT will likely outpace rigorous evaluations of their advantages and disadvantages relative to simpler techniques. Opportunities exist in virtually all anatomic sites for observational and randomized studies to evaluate the clinical impacts of these modern techniques in the palliative setting.
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Affiliation(s)
- Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
| | - Kelly Linden
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
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Muirhead R, Aggarwal A. Real World Data - Does it Cut the Mustard or Should We Take it With a Pinch of Salt? Clin Oncol (R Coll Radiol) 2023; 35:15-19. [PMID: 36272863 DOI: 10.1016/j.clon.2022.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 01/05/2023]
Affiliation(s)
- R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - A Aggarwal
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Gondhowiardjo SA, Handoko, Tham I, Giselvania A, Bilimagga RS, Octavianus S, Hiraoka M, Jayalie VF, Tamaki T, Calaguas M, Nakano T. Regional collaboration to improve quality of radiation therapy in Asia. J Med Imaging Radiat Oncol 2020; 65:424-430. [PMID: 33319494 DOI: 10.1111/1754-9485.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
In Asia, several challenges hinder the delivery of high-quality cancer treatment, especially radiation therapy (RT). Many Asian countries face large-scale shortage of RT centres and treatment machines. Additionally, there is also a significant technological gap, with many RT centres in Asia still using outdated technology. There is an urgent need to improve radiation treatment quality in Asia. The Federation of Asian Organizations for Radiation Oncology (FARO) was set up to foster regional collaboration, which we believe can help to identify and solve some of these issues collectively. This report describes the background and rationale of starting FARO, and puts forth some of the early achievements of the group, including fact-finding and educational activities. Finally, we discuss future possibilities, including strategic proposals that may benefit the RT community and our patients in Asia.
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Affiliation(s)
- Soehartati A Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Handoko
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ivan Tham
- Radiation Oncology Centre, Mt Elizabeth Novena Hospital, Singapore City, Singapore
| | - Angela Giselvania
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ramesh S Bilimagga
- Department of Radiation Oncology, HealthCare Global (HCG) Enterprises (Bangalore Institute of Oncology), Bangalore, Karnataka, India
| | - Steven Octavianus
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Masahiro Hiraoka
- Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Vito Filbert Jayalie
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Fukushima Medical University, Fukushima, Japan
| | - Miriam Calaguas
- Division of Radiation Oncology, Department of Radiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Takashi Nakano
- Quantum Medical Science Directorate, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
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Hayden K, Connolly M. Palliative radiotherapy: what do nurses know? ACTA ACUST UNITED AC 2019; 28:1202-1206. [PMID: 31597058 DOI: 10.12968/bjon.2019.28.18.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit. AIM the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis. METHODS a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses. FINDINGS the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education. CONCLUSION nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted.
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Affiliation(s)
- Kim Hayden
- Clinical Nurse Specialist, Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Michael Connolly
- Joint Associate Professor of Clinical Nursing, University College Dublin School of Nursing, Midwifery and Health Systems, and Our Lady's Hospice and Care Services, Dublin, Ireland
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
| | - Rhona Parrish
- Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
| | - Rachael Barton
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Ann Henry
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
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Price J, Wolfe T, Shawcroft E, Sundar S. Single-fraction Radiotherapy Should be the Standard of Care for Palliation of Cancer Symptoms in Patients with Limited Life Expectancy. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Morris EJA, Finan PJ, Spencer K, Geh I, Crellin A, Quirke P, Thomas JD, Lawton S, Adams R, Sebag-Montefiore D. Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service. Clin Oncol (R Coll Radiol) 2016; 28:522-531. [PMID: 26936609 PMCID: PMC4944647 DOI: 10.1016/j.clon.2016.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS Radiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neoadjuvant setting and postoperatively, but, although it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. These variations can have a significant effect on commissioning, but also future clinical research. This study explores its use within the large English National Health Service (NHS). MATERIALS AND METHODS Information on all individuals diagnosed with a surgically treated rectal cancer between April 2009 and December 2010 were extracted from the Radiotherapy Dataset linked to the National Cancer Data Repository. Individuals were grouped into those receiving no radiotherapy, short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and postoperative radiotherapy (PORT). Patterns of use were then investigated. RESULTS The study consisted of 9201 individuals; 4585 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.1%, SCRT-D in 1.2%, LCCRT in 29.5%, ORT in 4.7% and PORT in 2.3%. Radiotherapy was used more commonly in men and in those receiving an abdominoperineal excision and less commonly in the elderly and those with comorbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease. CONCLUSION Despite the same evidence base, wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported early and late toxicity information is required to further improve patient selection for preoperative radiotherapy.
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Affiliation(s)
- E J A Morris
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK.
| | - P J Finan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK; National Cancer Intelligence Network, London, UK
| | - K Spencer
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK; Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - A Crellin
- Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - P Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - J D Thomas
- National Cancer Registration Service, Northern and Yorkshire Office, St James's Institute of Oncology, St James's University Hospital, Leeds, UK; Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - S Lawton
- Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - R Adams
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - D Sebag-Montefiore
- Section of Clinical Oncology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
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Munro A. Multidisciplinary Team Meetings in Cancer Care: An Idea Whose Time has Gone? Clin Oncol (R Coll Radiol) 2015; 27:728-31. [DOI: 10.1016/j.clon.2015.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/19/2015] [Indexed: 12/24/2022]
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Bridge P, Dempsey S, Giles E, Maresse S, McCorkell G, Opie C, Wright C, Carmichael MA. Practice patterns of radiation therapy technology in Australia: results of a national audit. J Med Radiat Sci 2015; 62:253-60. [PMID: 27512571 PMCID: PMC4968555 DOI: 10.1002/jmrs.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/25/2015] [Accepted: 07/10/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. METHODS The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. RESULTS Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. CONCLUSIONS In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning.
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Affiliation(s)
- Pete Bridge
- School of Health Sciences Queensland University of Technology Brisbane Queensland Australia
| | - Shane Dempsey
- The University of Newcastle Callaghan New South Wales Australia
| | - Eileen Giles
- University of South Australia Adelaide South Australia Australia
| | | | | | - Craig Opie
- Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards New South Wales Australia
| | | | - Mary-Ann Carmichael
- School of Health Sciences Queensland University of Technology Brisbane Queensland Australia
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Examining Determinants of Radiotherapy Access: Do Cost and Radiotherapy Inconvenience Affect Uptake of Breast-conserving Treatment for Early Breast Cancer? Clin Oncol (R Coll Radiol) 2015; 27:465-71. [PMID: 26009548 DOI: 10.1016/j.clon.2015.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/18/2015] [Accepted: 04/29/2015] [Indexed: 11/24/2022]
Abstract
AIMS Radiotherapy utilisation is likely affected by multiple factors pertaining to radiotherapy access. Radiotherapy is an integral component of breast-conserving treatment (BCT) for early breast cancer. We aimed to determine if stepwise improvements in radiotherapy access in regional Australia affected the uptake of BCT and thus radiotherapy. MATERIALS AND METHODS Breast cancer operations in the Central Coast of New South Wales between January 2010 and March 2014 for T1-2N0-1M0 invasive or in situ (≤5 cm) disease in female patients eligible for BCT were examined. BCT uptake was calculated for three 1 year periods: period 1 (local radiotherapy available at cost to user or out of area radiotherapy with travel cost and inconvenience); period 2 (as per period 1 + publicly funded transport and radiotherapy at out of area facilities at no cost to user); period 3 (as per period 1 + publicly funded local radiotherapy at no cost to user). RESULTS In total, 574 cases met eligibility criteria. BCT declined with increasing distance to publicly funded radiotherapy (P = 0.035). BCT rates for periods 1, 2 and 3 were 63% (113/180), 61% (105/173) and 71% (156/221). There were no statistically significant differences in BCT between periods 1 and 2 in the whole cohort or within age, histology or tumour size subgroups. Overall, there was a 9% increase in BCT in the whole cohort in period 3 compared with periods 1 and 2 (P = 0.031). This increase was statistically significant for women over 70 years (19% increase, P = 0.034), for women with ductal carcinoma in situ (25% increase, P = 0.013) and for women with primary tumours that were ≤10 mm (21% increase, P = 0.016). CONCLUSIONS Improving the affordability of radiotherapy through publicly funded transport and radiotherapy at out of area facilities did not improve BCT uptake in a region where radiotherapy was locally available, albeit at cost to the user. Improving both affordability and convenience through the provision of local publicly funded radiotherapy increased BCT uptake. Service availability and affordability have long been recognised as important determinants of radiotherapy access. Our findings suggest that inconvenience may also influence radiotherapy utilisation.
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Chalubinska-Fendler J, Fendler W, Spych M, Luniewska-Bury J, Mlynarski W, Fijuth J. Availability and outcomes of radiotherapy in Central Poland during the 2005-2012 period - an observational study. BMC Cancer 2015; 15:214. [PMID: 25884958 PMCID: PMC4389344 DOI: 10.1186/s12885-015-1236-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using a cross-database integrative approach, we performed an epidemiological analysis in a representative region of central Poland to evaluate the availability of radiotherapy (RTx) and overall survival of adult patients undergoing RTx for cancer. METHODS Epidemiological data on cancer incidence in the 2005-2012 period were obtained from the Nationwide Cancer Registry. Using data from the Ministry of Internal Affairs, we collected survival information of all patients treated in the only centre providing RTx for a region inhabited by approximately 2.6 million people. RESULTS After filtering out individuals on the basis of exclusion criteria, the final dataset covered 17,736 patients. Availability of RTx increased marginally, from 23.5% (2005) to 24.4% (2011, R = 0.39, p = 0.38), with the highest values noted in patients with cervical (78.5%), prostate (70.6%) and breast cancer (62.7%). However, due to the decreasing population of the region, we noted increasing disparity in the likelihood of receiving RTx depending on the patient's area of residence, with rural areas becoming progressively more neglected. The best prognosis was noted among patients with breast or prostate cancer with 5-year OS rates reaching 81.2% and 83.3%, respectively. Multivariate analysis controlling for type of diagnosis and patient age showed a time-dependent improvement in outcomes (HR(95% CI): 0.96(0.94-0.98); p < 0.0001). CONCLUSIONS Availability of RTx in Poland is still below that reported by developed European centres. Survival of patients undergoing radical RTx has gradually improved, although it is still below that of leading RTx departments, potentially due to delayed diagnosis or organisational barriers, necessitating further investigations.
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Affiliation(s)
| | - Wojciech Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland.
| | - Michal Spych
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
| | - Jolanta Luniewska-Bury
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
| | - Wojciech Mlynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland.
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
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Aggarwal A, Cathcart P, Payne H, Neal D, Rashbass J, Nossiter J, van der Meulen J. The National Prostate Cancer Audit — Introducing a New Generation of Cancer Audit. Clin Oncol (R Coll Radiol) 2014; 26:90-3. [DOI: 10.1016/j.clon.2013.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/09/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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